Lipodystrophy, Body Changes and HIV/AIDS

What Is Lipodystrophy?

Lipodystrophy means abnormal fat changes. It is used to describe a number of
changes in body fat that are experienced by many people living with HIV (HIV+).
Lipodystrophy can also include changes in fat and sugar levels in the blood of
HIV+ people.

Although there is no official definition of lipodystrophy in HIV, it is
generally broken down into two categories:

Body shape changes -- Includes fat loss (lipoatrophy) and fat gain
(lipoaccumulation or lipohypertrophy) or movement of fat from one area to
another (redistribution) in particular areas of the body

Metabolic complications -- Includes increases in fats and sugars in the
blood

HIV+ people can experience both body shape changes and metabolic
complications. This is sometimes called lipodystrophy syndrome.

Body Shape Changes

Changes in the shape of your body can be caused by fat loss, fat build up,
or fat redistribution.

Fat loss may happen in the:

Arms and legs (fat loss may cause veins to appear larger in the arms and
legs)

Buttocks

Face (sunken cheeks)

Fat build up may happen in the:

Stomach

Breasts

Back of the neck ("buffalo hump")

Round lumps of fat may appear under the skin (lipomas)

Some studies show that lipodystrophy affects men and women differently.
Women are more likely to see fat gain in their breasts and stomachs while men
are more likely to see fat loss in their legs, arms, buttocks, or faces.
However, many men and women suffer from both symptoms. It is not clear why
there might be differences based on sex. It may have something to do with
hormones or with how men and women burn fat differently.

Lipodystrophy can dramatically change your appearance. These changes can
leave some people with feelings of poor self-image and low self-esteem. Some
people may want to stop taking their HIV drugs. Others may put off HIV
treatment due to fear of experiencing lipodystrophy symptoms. It is important
that you talk to your health care provider if you are feeling this way so that
you take the necessary steps to improve your health.

Metabolic Complications

Changes in fat (lipids) and sugar (glucose) in your blood are called
metabolic complications and include:

Increased lipids in your blood such as cholesterol and triglycerides (hyperlipidemia)

Increased glucose levels (hyperglycemia)

Insulin resistance or diabetes

Increased lactic acid in your blood (lactic acidemia)

Metabolic changes cannot be seen with the naked eye; they can only be
confirmed through blood tests. Without treatment, they can cause serious
long-term health problems.

Increased levels of cholesterol and triglycerides can put you at a higher
risk of developing heart disease or having a heart attack or stroke.

Increased glucose and insulin levels greatly increase the chance of
developing diabetes, a disease that can cause vision and kidney problems and may be
life threatening.

Increased lactic acid can lead to a rare but dangerous condition called lactic acidosis. Symptoms include nausea, vomiting, or stomach pain;
feeling very weak and tired; and shortness of breath.

It is important that you and your health care provider make sure you get
regular lab tests to check for metabolic complications. Call your health care
provider right away if you are experiencing symptoms of lactic acidosis.

What Causes Lipodystrophy?

Scientists have many theories about what causes lipodystrophy and research
in this area is ongoing. However, the exact causes of lipodystrophy are still
unknown. There may be different causes for different symptoms.

Fat loss: Research shows that
certain HIV drugs from the nucleoside reverse transcriptase inhibitor (NRTI)
class are the main cause of fat loss. These drugs are Retrovir (zidovudine, AZT
or ZDV) and Zerit (stavudine, d4T)

Fat gain: It is less clear
what causes fat gain. Taking protease inhibitors (PIs), another class of HIV
drug, may increase the risk of fat accumulation. Another theory is that insulin
resistance and increased lipid levels play a role in fat gain.

Increased lipids: Some of the
PIs are believed to increase lipid levels. It is still not clear which ones are
most likely to do this, but Reyataz (atazanavir or ATV) seems to be the least
likely PI to cause increased lipid levels

Increased glucose levels, insulin
resistance, and diabetes: Both PIs and NRTIs have been linked to
insulin resistance and diabetes

Lactic acidosis: Some of the
NRTIs are associated with lactic acidosis, especially Zerit and Videx
(didanosine, ddI).

Not everyone taking HIV drugs develops body shape changes or problems with
fat or sugar levels in the blood. Researchers have been looking for other
factors that may cause lipodystrophy. The following appear to be risk
factors:

Starting HIV treatment with lower CD4 cell counts

Starting HIV treatment at an older age

Being on an HIV drug regimen containing certain PIs and NRTIs (the longer
the time on the regimen the higher the risk)

This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

(Please note: Your name and comment will be public, and may even show up in Internet search results. Be careful when providing personal information! Beforeadding your comment, please read TheBody.com's Comment Policy.)

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.